Basic Information
| Provider Information | |||||||||
| NPI: | 1457961435 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOSTER | ||||||||
| FirstName: | ZACHERY | ||||||||
| MiddleName: | O'NIEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8915 SW CENTER ST | ||||||||
| Address2: | |||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972236307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037263690 | ||||||||
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| Practice Location | |||||||||
| Address1: | 326 SE MARLIN AVE | ||||||||
| Address2: | |||||||||
| City: | WARRENTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971469624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033255722 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2020 | ||||||||
| LastUpdateDate: | 09/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.